Obesity 2

Question 1

obesity/readiness to change (3)

Answer 1

1. appropriate timing
2. ask if it is ok to discuss, if they want to lose weight
3. meet patients where they are

Question 2

stages of change

Answer 2

1. Pre-contemplation
2. contemplation
3. preparation
4. action
5. maintenance; stages are cyclical and dynamic.

Question 3

lookAHEAD study: 5-10% of weight loss improves:

Answer 3

1. blood pressure
2. blood glucose
3. triglycerides

Question 4

diabetes prevention program

Answer 4

intensive lifestyle intervention can reduce progreassion from prediabetes to diabetes

Question 5

weight bias/stigma: care of patients with obesity vs. normal weight peers:

Answer 5

Providers spend less time in the room
Providers refer for routine screenings at lower rates

Question 6

effect of weight bias on patients with obesity

Answer 6

Depression
Decreased physical activity
Decreased patient engagement and follow-up

Question 7

steps for providers/educators

Answer 7

Be aware of our own attitudes and not let it affect patient management
Be aware that weight stigma is not an effective motivator for patients
Be aware of the example we set for healthcare trainees

Question 8

Weight History includes (9)

Answer 8

1. Length of overweight?
2. Highest weight?
3. Why do they want to lose weight?
4. Precipitating factors?
5. History of unexplained rapid weight gain?
6. History of weight loss attempts and efficacy?
7. Current dietary intake, home cooking environment
8. PMHx: weight-related comorbidities
9. Family Hx: overweight, diabetes, thyroid dz

Question 9

supportive office environment: speech

Answer 9

1. “People-first” language: “patient with obesity” not “obese patient”
2. Avoid hurtful comments or jokes
3. Terminology

Question 10

supportive office environment: space

Answer 10

1. Sturdy, armless chairs/high firm sofas/sturdy, wide exam tables
2. Extra-large patient gowns
3. Reading materials focusing on healthy habits, not looks or being “thin”

Question 11

supportive office environment: equipment

Answer 11

1. scales to measure over 400 pounds
2. Large adult or thigh blood pressure cuffs

Question 12

kcal/gram:
fat
ETOH
protein
carb
sugar alcohols
artificial sweeteners

Answer 12

Fat=9 kcal/gram
ETOH=7 kcal/gram
Protein= 4 kcal/gram
Carb/Sugar/Starch= 4 kcal/gram
Sugar Alcohols= ~2.6 kcal/gram
Artificial Sweeteners= ~1 kcal/gram

Question 13

carbs

Answer 13

• Preferred source of fuel for the brain and muscles; spares protein.
• Examples: starches, starchy vegetables, beans/legumes, fruit, milk and
  yogurt products, sugar

Question 14

white vs whole wheat carbs

Answer 14

similar calories, whole wheat has more fiber and nutrients

Question 15

milk variation in carbs

Answer 15

all same carbs, protein and calcium
fat content changes total calories

Question 16

protein

Answer 16

• Necessary for building and maintaining muscle and bone mass.
• Some research suggests consuming 20-30 gm/meal is beneficial for satiety, bones and muscle mass.

Question 17

fats

Answer 17

• Necessary for providing essential fatty acids, absorption of fat-soluble vitamins (A, D, E, K), important for brain function, growth and cushioning for organs.
• Hidden sources: Fast foods, prepared foods

Question 18

partially hydrogenated fats =

Answer 18

trans fats

Question 19

gold standard for weight loss

Answer 19

caloric deficit

Question 20

diets for comorbidities

Answer 20

DASH diet (dietary approaches to stop hypertension)
Mediterranean diet: decreased LDL-C and CV mortality
Low glycemic index diet: prediabetes or diabetes

Question 21

does type of diet matter for weight loss?

Answer 21

no, just adherence

Question 22

calorie goal =

Answer 22

TEE - (500-750 kcal/day)

Question 23

1 lb = _ calories

Answer 23

1 lb = 3,500 calories

Question 24

weight < 250 lbs should consume _
weight > 250 lbs should consume _

Answer 24

weight < 250 lbs should consume 1200-1500 kcal/day
weight > 250 lbs should consume 1500-1800 kcal/day

Question 25

5 dietary plans for weight control

Answer 25

- Meal replacements - Meal delivery services - Very low calorie diets (VLCD): < 800 kcal/day - Elimination or decrease liquid calories (juice, soda, alcohol) - My plate/healthy eating plate: macronutrient portions

Question 26

comparing atkins, zone, weight watchers, and ornish diets at 1 year

Answer 26

each modestly reduced weight and cardiac risk factors increased adherence = greater weight loss

Question 27

intermittent (IER) vs continuous energy restriction (CER) with weight loss

Answer 27

both reduced frequency of food consumption and overall energy intake no difference in weight loss

Question 28

IER vs. CER: insulin resistance

Answer 28

IER had greater decrease in insulin/insulin resistance

Question 29

IER vs. cER A1c, cholesterol

Answer 29

no sig diff

Question 30

energy density/calorie density (ED/CD)

Answer 30

number of calories (energy) in a specific amount of food per gram

Question 31

4 key components that affect ED:

Answer 31

1. Water (raisins vs. grapes) 2. Fat (ice cream vs. lowfat yogurt) 3. Fiber (broccoli vs. white rice) 4. Air (popcorn vs. pretzels)

Question 32

high ED = __ calories per gram

Answer 32

high ED = **a lot of** calories per gram

Question 33

low ED = __ calories per gram

Answer 33

low ED = **a few** calories per gram

Question 34

grapes vs raisin energy density

Answer 34

grapes are low, raisins are medium

Question 35

nutirent density (ND)

Answer 35

how many nutrients per 100 calories

Question 36

9 healthy nutrients considered in ND

Answer 36

protein, fiber, vitamins A, C, and E, calcium, magnesium, iron, and potassium

Question 37

high nutrient dense (HND) foods

Answer 37

whole grains, fruits, vegetables, dairy, lean proteins

Question 38

non-nutrient dense (NND) foods

Answer 38

potato chips, white bread/starch, soda, non-fruit juice, high fat proteins

Question 39

glycemic index (GI)

Answer 39

how quickly and how much a food increases blood sugar (0-100)

Question 40

100 GI indicates

Answer 40

how much a 50 g carb raises glucose over 2 hours

Question 41

lower GI means, carb is digested/absorbed at a __ rate, __ rise in blood sugar

Answer 41

lower GI means, carb is digested/absorbed at a **slower** rate, **slower** rise in blood sugar

Question 42

higher GI means, carb is digested/absorbed at a __ rate, __ rise in blood sugar

Answer 42

higher GI means, carb is digested/absorbed at a **quicker** rate, **rapid** rise in blood sugar

Question 43

glycemic load (GL)

Answer 43

measure of foods that takes into account impact of carb on blood sugar (GI) AND amount of carb in a typical serving of the food

Question 44

GL =

Answer 44

glycemic index x amount of carb/100

Question 45

3 categories of glycemic load

Answer 45

Low (10 or under) Med (11-19) High (20+)

Question 46

eating low GL foods can reduce __ and promote __

Answer 46

eating low GL foods can reduce **calories** and promote **fullness**

Question 47

addition of fat __ digestion and absorption of carbs, __ GL, but __ calories

Answer 47

addition of fat **slows** digestion and absorption of carbs, **decreases** GL, but **increases** calories

Question 48

GI of apple, watermelon baked potato (and GL)

Answer 48

apple < watermelon < baked potato

Question 49

insoluble fiber

Answer 49

increases the water-holding capacity of undigested food, which leads to increased bulk and frequency of defecation

Question 50

insoluble fiber __ constipation

Answer 50

insoluble fiber **improves** constipation

Question 51

insoluble fiber examples

Answer 51

leafy greens berries Fiber One

Question 52

soluble fiber

Answer 52

forms gels, slows GI transit time

Question 53

soluble fiber is helpful for (3)

Answer 53

constipation, diarrhea, and high cholesterol

Question 54

soluble fiber examples

Answer 54

apples, oatmeal, legumes

Question 55

resistant starch

Answer 55

unable to be digested, reduces number of calories absorbed

Question 56

resistant starch examples

Answer 56

raw oats some legumes